Measles treatment in Somalia requires an adapted response

As the conflict in Somalia’s capital city, Mogadishu, reaches new heights, Médecins Sans Frontières (MSF) is still managing to curb the worst effects of an ongoing measles outbreak in neighbouring regions.

FACTS ON MEASLES

One dose of measles vaccine before a child’s first birthday can protect a child against the disease. Source: WHO

Measles is a leading cause of death among young children.

In 2007, there were an estimated 197,000 measles deaths globally – that’s nearly 540 deaths every day or 22 deaths every hour.

More than 95 per cent of measles deaths occur in low-income countries with weak health infrastructure.

MSF delivers health care in eight regions in south and central Somalia based on medical need and regardless of clan or political affiliation.

In 2008, MSF teams provided nearly 730,000 outpatient consultations, including more than a quarter of a million for children under five. Some 24,000 people were admitted as in-patients to MSF supported hospitals and health clinics, and close to 4,000 surgeries were performed with 1,249 for injuries caused by violence. Nearly 35,000 people suffering from malnutrition were provided with food and medical care.

For its work in Somalia, MSF does not accept funding from any government or donor agency, and relies solely on donations from the general public.

The people in Guri El know that as soon as a child comes down with a high fever, red eyes and tiny spots on the inside of the mouth, they need to isolate the child from other children.

In a country where years of conflict have all but destroyed the health care system, MSF staff have taught these people to take their health into their own hands when it comes to one of the major childhood killers: measles.

Since April 11, an outbreak of this highly contagious disease has been sweeping through the town of Guri El and its surroundings in the Galgaduud region of south and central Somalia. So far MSF has treated 403 patients for measles related complications in the area.

Normally measles affects small children the worst, but in this case 60 per cent of patients are older than five years – some are even adults.

“The children under five have benefited from the systematic vaccination activities which MSF has carried out in the hospital over the past three years – but irregular vaccination in the area previously might explain the high proportion of older children and adults affected”, said Said Ibrahim Hassan, MSF’s field coordinator for the Galgaduud project.

Treatment of complications

There is no cure for measles, but it is possible to treat or prevent potentially fatal or debilitating complications. This is particularly important in places with little access to health care and widespread malnutrition, like Somalia.

The MSF-run Istarlin hospital has opened an extra ten beds in a separate building and dedicated a number of staff for exclusive care of patients with severe measles complications. Less critical patients are cared for in an isolated part of the outpatient department.

Alternative approach

Many people in Galgaduud are nomads, living scattered over a vast area and frequently on the move in search of water and fodder for their goats and camels. Along with the ongoing conflict, this makes it unrealistic to launch a major vaccination campaign in the area.

Instead the MSF team has chosen an alternative: as well as treating patients with measles who are brought to the hospital, one mobile team is visiting villages and settlements daily, up to 50 km from Guri El, to look for and treat infected people and inform clan elders, religious leaders, teachers and authorities to bring sick children to the hospital for care.

The mobile team adapts their itinerary according to where people move and where security permits. So far the results are good: more than 40 per cent of all measles cases treated have been treated in the patient’s home town. Only one child is reported to have died because of measles in the area.

“The information that we have suggests a mortality lower than you would expect. We believe that actively looking for cases, visiting the villages to treat patients and involving the communities have helped a lot,” explained Hassan.

More measles

Neighbouring regions are also feeling the affects of the epidemic.

In the last two weeks of April, MSF teams vaccinated more than 16,000 children aged between six months and 15 years in Belet Weyne, in the Hiraan region just south of Galgaduud, and in Galkayo, in Mudug region, teams have treated more than 230 patients from mid-April to mid-June.

Security conditions dictate how and where MSF can work and explain the different approaches to managing the measles outbreak.

Currently MSF is looking at the possibilities of launching a major vaccination campaign in the camps along the road between Afgooye and Mogadishu, where hundreds of thousands of people have sought refuge due to the recent escalation of violence in Mogadishu.